Method and apparatus for manufacturing an implant

ABSTRACT

An orthopedic implant manufacturing method. The method includes preparing a pre-operative surgical plan for a specific patient, the surgical plan including a three-dimensional image of a patient&#39;s joint indicating at least one resection plane, communicating the surgical plan to a surgeon of the patient, and receiving approval of the surgical plan and the resection plane by the surgeon. The method also includes providing automated osteophyte/protrusion removal control for surgeon manipulation, receiving a modified three-dimensional image of a patient&#39;s joint indicating an osteophyte/protrusion removal and a recommendation for a corresponding selected orthopedic implant from the surgeon, and requesting manufacture of the selected orthopedic implant.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/371,096, filed on Feb. 13, 2009, now issued as U.S. Pat. No.9,907,659, which is a continuation-in-part of U.S. patent applicationSer. No. 12/103,824, filed on Apr. 16, 2008, which claims the benefit ofU.S. Provisional Application Ser. No. 60/912,178, filed on Apr. 17,2007.

The disclosures of the above applications are incorporated herein byreference.

INTRODUCTION

Various methods of manufacturing patient specific and off-the selfimplant components are known.

The present teachings provide a surgeon-interactive manufacturing methodthat includes automated osteophyte or other protrusion removal control.

SUMMARY

The present teachings provide an orthopedic implant manufacturingmethod. The method includes preparing a preliminary pre-operativesurgical plan for a specific patient, communicating the plan to asurgeon of the patient, and receiving an orthopedic implant designrecommendation of the surgeon. The implant design recommendation caninclude selecting one of first, second or third options, the firstoption being a patient-specific implant, the second option being asemi-custom implant, and the third option being an off-the-shelfimplant. The method further includes sending a request for manufacturingthe selected implant to a manufacturing center, receiving the implant,and forwarding the implant for implantation.

In another aspect, the orthopedic implant manufacturing method includesproviding a generic casting of a specific implant component, the genericcasting having at least one geometric feature that can be machined to aplurality of different sizes of the implant component, the genericcasting including size-independent features of the specific component,and machining the component to a patient-specified size.

The present teachings also provide a device that includes a genericcasting for a specific implant component, the generic casting beingintermediate between stock material and a specific size implantcomponent. The generic casting includes at least one size-independentfeature of the implant component, and at least one feature machinable tosize/shape for a specific patient.

The present teachings also provide an orthopedic implant manufacturingmethod. The method includes preparing a pre-operative surgical plan fora specific patient, the surgical plan including a three-dimensionalimage of a patient's joint indicating at least one resection plane,communicating the surgical plan to a surgeon of the patient, andreceiving approval of the surgical plan and the resection plane by thesurgeon. The method also includes providing automatedosteophyte/protrusion removal control for surgeon manipulation,receiving a modified three-dimensional image of a patient's jointindicating an osteophyte/protrusion removal and a recommendation for acorresponding selected orthopedic implant from the surgeon, andrequesting manufacture of the selected orthopedic implant.

In another aspect, the method includes preparing a pre-operativesurgical plan for a specific patient, the surgical plan including athree-dimensional image of a patient's joint indicating at least oneresection plane, communicating the surgical plan to a surgeon of thepatient, receiving approval of the surgical plan and the resection planeby the surgeon, and identifying a location of at least oneosteophyte/protrusion on the three-dimensional image of a patient'sjoint. The method also includes providing a plurality of depth contoursin relation to the osteophyte/protrusion, providing at least onegraphical removal tool associated with the osteophyte/protrusion formanipulation by the surgeon, receiving a modified three-dimensionalimage of a patient's joint indicating an osteophyte/protrusion removaland a recommendation for a corresponding selected orthopedic implantfrom the surgeon, and requesting manufacture of the selected orthopedicimplant.

In a further aspect, the method includes preparing a pre-operativesurgical plan for a specific patient, the surgical plan including athree-dimensional image of a patient's joint indicating at least oneresection plane, identifying a location of at least oneosteophyte/protrusion on the three-dimensional image of a patient'sjoint, providing a plurality of depth contours in relation to theosteophyte/protrusion, and providing at least one graphical removal toolassociated with the osteophyte/protrusion for manipulation by a user.The method also includes, communicating the surgical plan to a user,receiving a modified three-dimensional image of a patient's jointindicating an osteophyte/protrusion removal and a recommendation for acorresponding selected orthopedic implant from a user, and requestingmanufacture of the selected orthopedic implant.

Further areas of applicability of the present teachings will becomeapparent from the description provided hereinafter. It should beunderstood that the description and specific examples are intended forpurposes of illustration only and are not intended to limit the scope ofthe present teachings.

BRIEF DESCRIPTION OF THE DRAWINGS

The present teachings will become more fully understood from thedetailed description and the accompanying drawings, wherein:

FIG. 1 is a flowchart of an implant manufacturing method according tothe present teachings;

FIG. 2 is a diagram illustrating a computer interface for an implantmanufacturing method according to the present teachings;

FIG. 3 is perspective view of a generic casting of an implant accordingto the present teachings;

FIG. 4 is a side view of a generic casting according to the presentteachings;

FIG. 5 is a plan view of a generic casting according to the presentteachings;

FIG. 6 is a flow chart for an osteophyte/protrusion removal controlmethod according to the present teachings;

FIG. 7 is a representative image of a patent's anatomy showingosteophyte/protrusion control tools for modifying the image;

FIGS. 8 and 9 are representative images of a patent's anatomy showingexemplary osteophyte/protrusion locations;

FIG. 10 is a representative image of a patent's anatomy showingrepresentative depth control selections for surgeon manipulation; and

FIGS. 11 and 12 are representative images of a patent's anatomy afterosteophyte/protrusion removal with exemplary implants attached thereon.

DESCRIPTION OF VARIOUS ASPECTS

The following description is merely exemplary in nature and is in no wayintended to limit the present teachings, applications, or uses. Forexample, although some of the present teachings are illustrated for aknee implant, the present teachings can be used for any orthopedicimplant.

The present teachings provide a manufacturing method that integratespatient's anatomic and medical information with interactiveparticipation by a surgeon to select and manufacture an implant and,optionally, related surgical instruments, for a particular patient fromgenerally three options: a custom made implant specific to the patient;an implant that is only partially custom-made or a semi-custom implant,and a standard off-the self implant. Similarly, off-the-self orcustom-made or semi-custom made instrumentation, such as alignmentguides, drill guides, cutting guides or other instruments can beselected and manufactured, as recommended by the surgeon, for thesurgical procedure. All the implant components, alignment guides andother disposable instruments can be included in a package provided to asurgeon for a specific patient.

Referring to FIG. 1 , an exemplary flowchart of an interactive implantmanufacturing method according to the present teachings is illustrated.At 100, the portion of the patient's anatomy related to the orthopedicprocedure and the implant is characterized and detailed with variousimaging methods capable of obtaining a representation of the affectedanatomy, including, for example, soft and hard tissues, such as bone, orbone joints with or without cartilage, ligaments or other soft tissue.The imaging methods can include, for example, MRI, CT, ultrasound,radiography or X-ray, cameras and other devices. The image informationfor the patient can be obtained at a medical facility or a doctor'soffice and can be sent to the manufacturer in an electronic/digital formcontained in a memory storage medium, such as a CD, DVD, memory stick,CF or SD card or other storage device, or as an electronic filetransmitted over the Internet or worldwide web or by using any otherelectronic communication methods, including e-mail or other digitaltransmission to any time of computer device, smart phone, PDA or otherdevices in which electronic information can be transmitted.

With continued reference to FIG. 1 , at 110, the information collectedat 100 can be used to create a three-dimensional model or image of thebone or joint with or without associated soft tissue or related anatomyusing commercially available computer modeling software from variousvendors or developers, such as, for example, from Materialise USA, AnnArbor, Mich. The three-dimensional model of the patient's anatomy can beviewed on a computer display or other electronic screen and can alsoreproduced as a hard copy on film or other medium and viewed by director indirect or backlight illumination.

At 120, soft tissue associated with the affected anatomy can bemodified, or removed or repaired, to restore alignment of the joint, forexample, or to remove torn or diseased tissue, or to cut or repairligaments, or to provide natural or artificial ligament grafts. Softtissue information can be optionally used as an additional designparameter or input for the implant design, at 125. For example, a customor patient-specific bearing articulation of a knee joint can be designedbased on the kinematic profile and the soft tissue/ligament informationavailable for a particular patient. Further, kinematic information forthe patient can be obtained by an actual gait analysis of the patient,and can also be obtained by computer modeling software that uses the MRIimages of the patient's joints and associated ligaments, muscle or othersoft tissue to derive kinematic analysis of the patient andcorresponding recommendations for soft tissue modification, such asreleasing a ligament, for example. Such software is commerciallyavailable from the Biomechanics Research Group, Inc., of San Clemente,Calif.

At 130, a preliminary pre-operative plan of the surgical procedure canbe prepared for surgeon or other medical user or technician review,including the planning of various bone resections, sizes and types ofimplants, and various geometric requirements including relevantdimensions, such as height, width, orientation of particular features,etc. The preliminary pre-operative surgical plan can include arecommendation of particular implants and associated instruments to beused in the surgical procedure, as discussed below. The preliminarypre-operative surgical plan can be in the form of digital images thatcan be viewed interactively using a computer modeling software, such asthe software referenced above.

At 140, the preliminary pre-operative surgical plan can be submitted tothe surgeon (or other user) for review, either electronically or by landmail, and either in digital or hard copy form, as discussed above inconnection with transmitting imaging information. In particular, thesurgeon can review the resection planes shown in image of the patient'sanatomy, make changes in the location, size and orientation of theresection planes and, generally, work interactively until thepre-operative plan from 130 is surgeon-approved. Specifically, thesurgeon may approve the image of the patient's anatomy showingcorresponding resection planes. As shown in FIGS. 7 and 8 , thepatient's anatomy 510 can be, for example, a distal femur with approvedresection planes including medial and lateral anterior chamfer planes513, medial and lateral anterior cut planes 511, medial and lateralposterior chamfer planes 512 and medial and lateral posterior cut planes514. Following the surgeon's approval of the anatomy and the resectionplanes at 140, the surgeon is provided with the opportunity to removeone or more osteophytes/protrusions from the image of the patient'sanatomy 510 at surgeon-selected locations and depths at 500 (See FIG. 6). Removal of such protrusions and smoothening of the joint surface thatreceives the implant can parallel the intra-operative joint preparationby the surgeon and improve the actual fit of a surgeon-selected implant,whether patient-specific, semi custom or off the shelf.

An automated osteophyte/protrusion removal control module 500 can beincorporated in the planning stage of the manufacturing methodillustrated in FIG. 1 . The automated osteophyte/protrusion removalcontrol module 500 can be provided as a separate pre-operative planningmodule, as shown in FIG. 6 , or it can be incorporated and/or fullyintegrated with the manufacturing method illustrated in FIG. 1 .

Certain parts of the bone, including various bone bumps, protrusions,growths and osteophytes can be generally removed from thethree-dimensional reconstruction of a patient's anatomy before designinga patient-specific implant or semi-custom implant, or before selectingan off the shelf implant. The automated osteophyte/protrusion removalcontrol module can replace a time-consuming and potentially lessaccurate manual modification of the three-dimensional image to removesuch bone growths or osteophytes by an experienced image or CADtechnician. The automated osteophyte/protrusion removal control module500 can provide more accurate and faster removal of such boneirregularities, which can vary in shape, location and size from patientto patient. It will be appreciated that the osteophyte/protrusionremoval control module 500 can be used for smoothing out a bone surfaceby removing any type of bone protrusion, including bumps, irregularitiesand osteophytes. According to the present teachings, osteophytes areillustrated as exemplary, but not exclusive, candidates for complete orpartial removal.

Referring to FIG. 6 , the osteophyte/protrusion removal control module500 can start 502 with an input of the three-dimensional image of thepatient's anatomy 510 including resection planes, as shown in FIGS. 7-9, after review and approval of the resection planes by the surgeon (orother user, including other professionals or technicians) at 140 of FIG.1 . In the exemplary illustration of FIG. 7 , the image of the patient'sanatomy 510 can be analyzed to identify osteophyte/protrusion locations530 (at 504 of FIG. 6 ) by determining tissue or bone overhangprotruding past outer edges 532 of the various resection planes, such asthe resection planes illustrated at 511, 513, 512 and 516 in FIGS. 7-9 .If such osteophyte/protrusions 530 extend beyond the edges of theresection planes in the direction of the planned or anticipated implantlocation, the osteophyte/protrusions 530 can interfere with implantfitting.

Referring to FIGS. 6, 7 and 10 , in addition to identifying the locationof osteophytes/protrusions 530, the osteophyte/protrusion removalcontrol module 500 can provide visual control for the surgeon to selectthe aggressiveness of osteophyte/protrusion removal, or the degree ofsmoothening and/or flattening of the corresponding joint anatomy.Specifically, by fine-tuning the osteophyte/protrusion locations, at 506of FIG. 6 , the surgeon can control the depth of theosteophyte/protrusion removal in a continuous or discrete manner. In oneaspect, a landmark location 540 for each osteophyte/protrusion 530 canbe identified and pegged for measuring from and initiating a continuousseries of constant or variable depth contours 542 to aid the surgeon inselecting the depth of osteophyte/protrusion removal. The depth contourscan be automatically generated by the computer software that generates athree-dimensional model or image of the anatomy, such as the softwarecommercially available, for example, from Materialise USA, Ann Arbor,Mich. The landmark location 540 can be a location of lowest possibledepth in the vicinity of the identified osteophyte/protrusion, aminimum, or a valley location, as shown in FIG. 10 . Although the depthcontours 542 are shown as discrete in FIG. 10 , it will be appreciatedthat a continuous removal control can be provided, such that the surgeoncan exercise unlimited choices of depth contours for removal. The depthcontours 542 can represent curved smoothed-out surfaces under theoriginal osteophyte/protrusion 530 and can be exposed after an overlyingarea is shaved or peeled in the image 510 by the operation of graphicalor visual removal tools provided on the image 510. The surgeon or otheruser can manipulate the graphical removal tools with a user interface,such as a mouse, touch screen, joystick, slide pad, or other userinterface.

Referring to FIG. 7 , various visual removal tools can be provided foron-screen manipulation and control by the surgeon, at 508 of FIG. 6 .For example, a removal tool corresponding to each edge of a resectionplane can be provided and used to visually/graphically remove portion ofan osteophyte/protrusion associated with a particular edge 532. In FIG.7 , four such exemplary removal tools 520 a, 520 b, 520 c, 520 d(collectively referenced as 520) are shown, each removal tool associatedwith an edge of a resection plane, such as lateral and medial chamferplane and lateral and medial cut plane. Although the removal tools 520are illustrated as straight sliders in FIG. 7 , the amount removedfollows a depth contour 542, as illustrated in FIG. 10 . The removaltools 520 can include a visual indicator 525 that can provideinformation to the surgeon in the form of a number on a scale indicativeof the depth of aggressiveness of osteophyte/protrusion removal. Inanother aspect, the indicator 525 can provide visual information interms of variable color in shades gradually changing from minimum depthremoval (green, for example) to maximum depth removal (red, forexample).

After the surgeon completes the osteophyte/protrusion removal, thesurgeon can manipulate and superimpose implant images in relation to themodified patient's anatomy 510. In FIGS. 11 and 12 , exemplary images ofa resected femur 510 and tibia 515 referenced in relation to amechanical axis 522 are illustrated. The femur image illustrates thepatient's anatomy 510 after the osteophytes/protrusions 530 shown inFIGS. 8 and 9 have been removed and a femoral component 560 is placed onthe resulting smoothed out surface that follows one of the depthcontours 542 shown in FIG. 9 .

Based on the preliminary pre-operative surgical plan and the patientinformation, the surgeon can make a recommendation regarding the designof the implant at 150, and any desired associated alignment guides at160. At 150, the surgeon can recommend a method of designing an implant.Specifically, the surgeon can select one of the following three options:a first option of a custom or patient-specific implant at 170 or asecond option of a semi-custom made implant at 180, or a third option ofa standard or off-the-shelf implant at 190. It will be appreciated that,based on the surgeon's recommendation at 140, the preliminarypre-operative surgical plan can be modified at 130 and then resubmittedto the surgeon for approval.

A custom-made implant is a patient-specific, one of a kind implantspecifically made for a particular patient, and consequently there is noinventory associated with such implant. Standard oroff-the-self-implants are available and stocked in a number of sizes,typically six or more, and a number of configurations or types,including bilateral or unilateral implants, constrained,semi-constrained, mobile, etc. Because of the variety of sizes andconfigurations that are kept in stock to be accommodate differentpatients, a large inventory of standard implants is created, and severalmolds for each type and size of implant may be used. As described belowin detail, semi-custom implants provide an intermediate solution betweencustom-made and off-the-self implants. Semi-custom implants reduce thesize of inventory and molds required for production, while allowing somedegree of patient-specific customization.

Custom or patient-specific implants, when approved by surgeon at 170 fora specific patient, can be manufactured for the patient by rapidprototyping methods, such as stereolithography or other similar methods,or by CNC milling, or other automated or computer-controlled machining,or by robotic methods, at 250. Manufacturing can take place at amanufacturing center or facility in situ or at remote or off-sitelocation. It will be understood that in situ manufacturing is used as ashort hand for a manufacturing site of the original equipmentmanufacturer (OEM), but can be physically located at a differentfacility of the OEM. Off-site or remote manufacturing will be understoodto refer to facilities operated by other manufacturers who arecontracted by the OEM for manufacturing all or some of the components orparts for the surgical procedure.

Off-the-self implants, when approved by the surgeon a 190, can bemanufactured by standard casting methods from bar stock or other stockmaterial at 200, then shaped to a final shape and size by grinding ormilling at 210, polished at 220, and then cleaned/passivated at 230.Such off-the-self implants can be part of an existing inventory, ormass-produced, or produced by just-in-time agile manufacturing methods.

Semi-custom implants, when approved by the surgeon at 180, can be madefrom a generic casting at 240, as described below, or by modifyingexisting standard implant designs to match various features orparameters based on the anatomy of the patient, as described inco-pending patent application entitled Patient-Modified Implant andAssociated Method, Ser. No. 12/103,834, filed on Apr. 16, 2008, thedisclosure of which is incorporated by reference herein. After thegeneric casting is modified for certain parameters of a patient, it canbe processed at aspects 210-230 to a passivated form. Patient-specificparameters can include parameters relating to the size of the implant,including height, width, various articulation parameters or angles,etc., as discussed in specific example below in reference to FIGS. 3-5 .

The surgeon's review of the surgical plan at 140 may further include, at160, a request for one or more patient-specific alignment guides to beused with the implant. Patient-specific alignment guides are describedin co-pending patent application Ser. No. 11/756,057, filed on May 31,2007, Ser. No. 11/971,390, filed on Jan. 9, 2008, Ser. No. 12/025,414,filed on Feb. 4, 2008, and Ser. No. 12/039,849 filed on Feb. 29, 2008.The alignment guides can be manufactured at 260 with by rapidprototyping methods, such as stereolithography or other similar methodsor by CNC milling, or other automated or computer-controlled machiningor robotic methods, and cleaned at 270. The alignment guides, theimplants and optionally other disposable instruments can be packaged andsterilized at 280, and forwarded to the surgeon or the surgeon's medicalfacility for implantation at 290.

Referring to FIG. 2 , a computer interface 400 to a computer program forthe management of the manufacturing method is illustrateddiagrammatically. An orthopedic system manager 402 can be in the form ofsoftware or other computer program associated with the originalequipment manufacturer. The orthopedic system manager 402 can beaccessible locally via dedicated computer machines or computer terminaldirectly communicated with software either by hard wire or wirelessly.The orthopedic system manager 402 can also be accessible remote remotelyvia the Internet or other remote communication portals using anyelectronic or other devices that can connect to the Internet or otherweb-based network, or other similar communication networks, includingcable, satellite and telephone-based networks.

The system manager 402 can provide access to patient file information,including lists of all current patients at 403, and surgery dates,surgeons, and approval status of the surgical plan for each patient, at404. Each patient file can include personal and medical information ofthe patient, such as, for example, weight, height, gender, age,lifestyle, pertinent medical records and medical history, as well asinformation on patient assessment that includes physical and kinematicevaluation pertaining to the orthopedic procedure at 406, and soft andhard tissue analysis at 408, including information provided at aspects120 and 125 of FIG. 1 , as discussed above. Imaging center informationfor patient scans, as discussed in relation to aspects 100 and 110 ofFIG. 1 , can added or modified at 410, and an imaging center for eachspecific patient can be specified at 412. Surgeon profiles, includingsurgeon preferences regarding anatomic axes alignment or implant andinstrument preferences that can be taken into account when preparing thepreliminary pre-operative plan discussed at aspect 130 of FIG. 1 , canbe created and edited at 414. Information and selection of manufacturingcenters can be accessed at 416 for manufacturing the implants and oralignment guides as discussed in relation to aspects 260, 250, 240, and210-230 of FIG. 1 . The preliminary pre-operative surgical plan for eachpatient can be provided at 418, as discussed above at 140 in referenceto FIG. 1 , and e-mailed or otherwise communicated to the patient'ssurgeon at 420.

As discussed above at aspects 150 to 190 of FIG. 1 , one implant optionincludes manufacturing semi-custom implants by generic casting.Illustrative examples of generic casting of a semi-custom femoralcomponent are shown in FIGS. 3-5 . A generic casting 300 of the implantis a casting that is more specialized than ordinary bar stock, fromwhich any size of component can be made, but less specialized than theoff-the-self components that are available in a particular number ofsizes, typically six-to ten sizes and are finished from specificcastings of those sizes. The generic casting can be made in a size andshape that can accommodate a range of variable features for thecomponent, and at the same time can be machined to multiple sizes, suchas three or four smaller sizes. In contrast, off-the-self implantsrequire a mold or casting for each offered size, and a larger inventoryof available sizes for each implant component. The generic casting cangenerally include geometric features which are size/shape and/orpatient-independent or universal, and also features that are size/shapeor patient-specific, as discussed in the examples below. Moreparticularly, the generic casting can include at least one geometricfeature that will remain unchanged for any patient or universal feature,and at least one geometric feature that can be specifically customizedfor and is specific to a particular patient.

Referring to FIGS. 4 and 5 , an exemplary generic casting 300 of afemoral component is illustrated. In this example, the generic casting300 can have an anterior flange 302 of medial-lateral width W, and/or aheight H and/or other geometric dimensions to accommodate multiple sizesof femoral components. For example, multiple sizes of left-sidedimplants 304 a, 304 b, and various sizes of right-sided implants 306 a,306 b can be formed by a single generic casting. Appropriate markings orindentations or score lines for cutting to size can be provided, such asheight markings 330, for example. The implant for a particular patientcan be formed from the generic casting 300 by selecting particularfeatures, such as the width W or height H, or other geometric featuresfor a particular patient and machining the generic casting 300 toprovide the size, dimension or shape, or combinations thereof for thatparticular geometric feature.

Referring to FIG. 5 , the generic casting 300 does not include a patellatrack feature, but provides an area in which a custom patella track 308can be machined at a custom angle for each specific patient. The genericcasting 300 can also include additional material in the inner condylarnotch area 310 to allow for custom machining of the intercondylar notcharea 310 to accommodate various types of articulation or constraint inrelation to a tibial component, such cams or intercondylar boxes, andother contact areas for articulation with the tibial component inaccordance with a kinematic plan for the joint of the specific patient.Separate molds for posterior stabilized and cruciate retainingarticulations can be made, each mold capable of accommodating multiplesizes of the corresponding implant type. For example, the intercondylarnotch area 310 can be machined for line or area contact with thearticular surfaces of a tibial component of various degrees of flexion.Exemplary articulations are disclosed in commonly assigned U.S. Pat.Nos. 6,589,283, 6,413,279, and 6,165,223, and in co-pending U.S. patentapplication Ser. No. 10/840,765 filed on May 6, 2004, all of which areincorporated herein by reference. Various markings 332 corresponding todifferent sizes can be provided.

Referring to FIG. 3 , the generic casting 300 can include at least onepatient-independent or universal feature, such as, for example,universal cement wells 312 or other universal features. Such universalfeatures can be used with any internal geometry 314, which can bemachined into the generic casting 300 to accommodate the appropriateshape and/or size for a specific patient.

It will be appreciated from the above discussion that generic castingcan greatly reduce inventory, machining costs and investment in moldtooling, while at the same time accommodating sizes and geometricfeatures specific to a patient. Specifically, each implant type can beformed from a generic casting that can accommodate multiple sizes, suchas four sizes, for example. For implants that are available in eightsizes, generic casting can reduce inventory by a half, using two moldstotal for eight sizes. Further, additional reductions in inventory canbe obtained by combining right and left side implants into a singlegeneric casting, as discussed above in relation to FIG. 4 .

The foregoing discussion discloses and describes merely exemplaryarrangements of the present teachings. Furthermore, the mixing andmatching of features, elements and/or functions between variousembodiments is expressly contemplated herein, so that one of ordinaryskill in the art would appreciate from this disclosure that features,elements and/or functions of one embodiment may be incorporated intoanother embodiment as appropriate, unless described otherwise above.Moreover, many modifications may be made to adapt a particular situationor material to the teachings of the invention without departing from theessential scope thereof. One skilled in the art will readily recognizefrom such discussion, and from the accompanying drawings and claims,that various changes, modifications and variations can be made thereinwithout departing from the spirit and scope of the present teachings asdefined in the following claims.

What is claimed is:
 1. A computer-aided surgical planning and orthopedicimplant preparation method comprising: obtaining digital medical imagingfiles of a patient; generating a pre-operative surgical plan for aspecific patient, the surgical plan including a digitalthree-dimensional model of the patient's joint generated from thedigital medical imaging files; marking at least one resection plane ofthe joint in the digital three-dimensional model; rendering the digitalthree-dimensional model on a display screen of a computer device forviewing by an operator; identifying a surface irregularity in thedigital three-dimensional model of the patient's joint proximate theresection plane by the operator using a graphical user interface of thecomputer device; utilizing an automated irregularity removal controlmodule of the computer device to digitally remove a portion of thesurface irregularity from the digital three-dimensional model of thepatient's joint by the operator using the graphical user interface;generating a modified digital three-dimensional model of the patient'sjoint indicating an irregularity removal relative to the at least oneresection plane; selecting an orthopedic implant corresponding to themodified digital three-dimensional computer model of the patient'sjoint, such that the selected orthopedic implant mates flush with the atleast one resection plane where the portion of the surface irregularitywas removed; generating a surgical plan including the selectedorthopedic implant; and storing the surgical plan in a computer readablestorage medium.
 2. The method of claim 1, wherein utilizing theautomated irregularity removal control module to digitally remove thesurface irregularity from the digital three-dimensional model of thepatient's joint comprises: displaying the digital three-dimensionalmodel of the patient's joint in the graphical user interface; receivinginput from an on-screen removal tool to graphically adjust an amount ofthe surface irregularity to remove in the graphical user interface; andremoving a portion of the surface irregularity in the digitalthree-dimensional model of the patient's joint corresponding to theamount of the surface irregularity removed using the on-screen removaltool to generate the modified digital three-dimensional model; whereinthe surface irregularity comprises a localized bone projection.
 3. Themethod of claim 2, wherein receiving input from the on-screen removaltool includes: generating a slider bar for display within the graphicaluser interface; and in response to input received from the slider bar,visually adjusting a height of the surface irregularity within thegraphical user interface.
 4. The method of claim 1, wherein utilizingthe automated irregularity removal control module to digitally removethe surface irregularity from the digital three-dimensional model of thepatient's joint comprises: displaying the digital three-dimensionalmodel of the patient's joint in the graphical user interface; measuringfrom a series of depth contours on the digital three-dimensional modelof the patient's joint a depth of the surface irregularity; andreceiving input within the graphical user interface for inserting alandmark location marker into the digital three-dimensional model of thepatient's joint to denote a location of lowest possible depth of thesurface irregularity.
 5. The method of claim 1, further comprisingoverlaying a digital model of the selected orthopedic implant on thedigital three-dimensional model of a patient's joint before generatingthe surgical plan.
 6. The method of claim 1, further comprising:communicating an electronic version of the pre-operative surgical planfrom a first location where the pre-operative surgical plan is generatedto a surgeon of the patient at a second location remote from the firstlocation; wherein utilizing the automated irregularity removal controlmodule to digitally remove the surface irregularity from the digitalthree-dimensional model of the patient's joint is performed at thesecond location.
 7. The method of claim 6, further comprising:electronically transmitting manufacturing instructions for the selectedorthopedic implant to a manufacturing center at a third location remotefrom the first and second locations; and manufacturing a physicalembodiment of the selected orthopedic implant.
 8. An orthopedic implantselecting method using a computer planning system, the methodcomprising: generating pre-operatively a computer model of a patient'sjoint from imaging information obtained from the patient; generating apreliminary resection plane on a bone of the joint in the computer modelin an electronic screen of a computer device; receiving an input from agraphical removal tool of the computer planning system with a userinterface of the computer device to identify a surface protrusion on thebone of the joint in the computer model that intersects the preliminaryresection plane; modifying the computer model with the user interface toremove at least a portion of the surface protrusion from the bone;selecting with the user interface one of first, second or third optionsfor an orthopedic implant to mate with the preliminary resection planeof the bone where the at least a portion of the surface protrusion wasremoved, the first option being a patient-specific implant, the secondoption being a semi-custom implant, and the third option being anoff-the-shelf implant; generating a surgical plan with the computerdevice, the surgical plan including the selected option for theorthopedic implant; storing the surgical plan in a computer readablestorage medium of the computer device; and storing design parameters formanufacturing the selected option for the orthopedic implant in thecomputer readable storage medium.
 9. The method of claim 8, whereinmodifying the computer model to remove at least a portion of the surfaceprotrusion from the bone comprises: displaying the computer model of thepatient's joint on the electronic screen; receiving an input from thegraphical removal tool to graphically adjust an amount of the surfaceprotrusion to remove; and removing a portion of the surface protrusionin the computer model corresponding to the amount of the surfaceprotrusion removed using the graphical removal tool to modify thecomputer model to remove the at least a portion of the surfaceprotrusion from the bone.
 10. The method of claim 9, further comprising:displaying the preliminary resection plane on the bone in the computermodel; identifying overhang of the surface protrusion into thepreliminary resection plane; and receiving an input from the graphicalremoval tool with the user interface to modifying the computer model toremove the overhang of the surface protrusion from the bone.
 11. Themethod of claim 9, wherein modifying the computer model to remove atleast a portion of the surface protrusion from the bone furthercomprises: measuring from a series of depth contours on the computermodel of the patient's joint to determine a depth of the surfaceprotrusion; and receiving an input with the user interface inserting alandmark location marker into the computer model of the patient's jointto denote a location of lowest possible depth of the surface protrusion.12. The method of claim 8, further comprising: communicating thecomputer model of the patient's joint to a surgeon of the patientlocated at a first location remote from where the imaging information isobtained from the patient; wherein operating the graphical removal toolwith the user interface to identify the surface protrusion on the boneof the joint in the computer model is performed by the surgeon at thefirst location.
 13. The method of claim 8, further comprising:transmitting a digital request for manufacturing the selected implant toa manufacturing center at a third location remote from the first andsecond locations; and receiving a physical embodiment of the selectedimplant from the manufacturing center at a fourth location remote fromthe first, second and third locations.
 14. The method of claim 8,further comprising overlaying a digital model of the selected option onthe computer model before generating the surgical plan.
 15. Acomputer-aided method for remotely selecting an orthopedic implant, themethod comprising: generating a computer file having a preliminarypre-operative surgical plan for a specific patient using a computingsystem at a first location, the preliminary pre-operative surgical planincluding a digital model of a joint of the specific patient;electronically communicating the computer file having the preliminarypre-operative surgical plan to a computer device of a surgeon of thepatient located at a second location; receiving a modified computer filehaving a modified pre-operative surgical plan from the surgeon using thecomputing system, the modified pre-operative surgical plan comprising: amodified digital model of the joint of the specific patient having amodification comprising at least one of a resection plane and a surfaceprotrusion modification that leaves a portion of the surface protrusionadjacent the resection plane; and a surgeon-selected orthopedic implantto fit with the modification; and storing the modified computer filehaving the modified pre-operative surgical plan in a computer readablestorage medium of the computing system.
 16. The method of claim 15,further comprising: storing design parameters for manufacturing thesurgeon-selected orthopedic implant in the computer readable storagemedium.
 17. The method of claim 16 further comprising: sending anelectronic request for manufacturing the surgeon-selected implant to amanufacturing center; receiving the implant at a medical facility at athird location, and implanting a physical embodiment of thesurgeon-selected implant into the specific patient; wherein thesurgeon-selected implant comprises a patient-specific implant.
 18. Themethod of claim 15, wherein the second location is located remotely fromthe first location.
 19. The method of claim 15, further comprising:displaying the digital model of the joint of the specific patient in agraphical user interface; receiving input from an on-screen removal tooland graphically adjusting an amount of an osteophyte removed from thejoint of the specific patient in the digital model; and removing aportion of the osteophyte corresponding to the amount of the osteophyteremoved using the on-screen removal tool in the digital model togenerate the modified digital model.
 20. The method of claim 19, furthercomprising: receiving measurements from a series of depth contours onthe digital model of the joint of the specific patient to determine adepth of the osteophyte; and receiving an indication of a landmarklocation marker, and inserting the landmark location marker into thedigital model of the joint of the patient to denote a location of lowestpossible depth of the osteophyte.